Transoral robotic surgery in oral tongue cancer patients with trismus: a retrospective evaluation of feasibility and surgical outcomes

Abstract

• TORS glossectomy is effective for oral tongue cancers with trismus or extension. • Trismus does not adversely affect surgical or functional outcomes with TORS. • TORS offers cancer control with minimal aesthetic impact and no external scars. • Negative margins achieved in 98.5 % of cases without open conversion. • TORS may improve trismus secondarily through incidental fibrotic tissue release. Transoral robotic surgery (TORS) has transformed the surgical management of head and neck tumors, yet its role in oral tongue cancers with trismus remains underexplored. Traditional open approaches for posterior or extensive tongue lesions are often associated with high morbidity and poor aesthetic outcomes. This study investigates the feasibility, safety, and outcomes of TORS glossectomy in oral tongue cancers, particularly in anatomically challenging cases such as those with trismus or tumor extension to adjacent structures. In this retrospective study, 67 patients with oral tongue cancer underwent TORS glossectomy by a single surgeon from April 2016 to December 2024. Patient demographics, tumor characteristics, operative details, and postoperative outcomes were analyzed. Comparative analyses were performed between patients with and without trismus. All patients successfully underwent TORS without conversion to open surgery. Negative surgical margins were achieved in 98.5% of cases. No significant differences were observed between trismus and non-trismus groups in operative time, blood loss, reconstruction rates, or functional outcomes. Notably, TORS enabled adequate exposure even in trismus cases and may have inadvertently improved mouth opening through fibrotic soft tissue release. The overall complication rate was low, and most patients resumed oral intake within two weeks. TORS glossectomy is a safe and effective technique for complex oral tongue cancer, including in patients with trismus or tumor extension. These findings support broader adoption of TORS as a minimally invasive alternative to traditional open surgery in select oral cavity malignancies.